Nagi B, Rana S S, Kochhar R, Bhasin D K
Section of Radiology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Abdom Imaging. 2006 Jul-Aug;31(4):417-24. doi: 10.1007/s00261-005-0356-y. Epub 2006 Jan 30.
Radiologic evaluation of small bowel is usually done by barium examination, which involves considerable radiation exposure. A new sonographic method, sonoenteroclysis, is a promising technique for diagnosing small intestinal disorders. In this study the applicability, performance, and diagnostic yield of sonoenteroclysis were assessed and the results of this novel method were compared with those of barium enteroclysis.
Forty-five consecutive patients with suspected small bowel disorder were studied. All patients underwent abdominal ultrasound before and after infusion of an isotonic nonabsorbable electrolyte solution containing polyethylene glycol through a nasojejunal tube (modified Billbao Dotter tube), and images at various levels were obtained. Small bowel wall thickness, luminal narrowing, intestinal dilatation, peristalsis, and extraintestinal complications were noted. It was followed by barium enteroclysis and findings were recorded. Findings of sonoenteroclysis were compared with those of barium enteroclysis.
Satisfactory distention of the intestinal lumen was obtained with sequential visualization of jejunoileal loops in 34.4 +/- 18.4 min. Of 45 patients, 10 showed normal small bowel on sonoenteroclysis and barium enteroclysis. These 10 patients served as controls. Sonoenteroclysis displayed normal diameters smaller than 3.0 and 2.0 cm for the jejunum and ileum, respectively. Bowel wall thickness was 1.7 to 3.0 mm and all five layers of bowel wall could be well appreciated. Valvulae conniventes were clearly visualized with a fold thickness between 1.4 and 2.0 mm. The remaining 35 patients showed abnormalities in the form of strictures, matted bowel loops, dilated loops, thickened folds, deformed ileocecal junction, mass lesions, etc., on sonoenteroclysis and barium enteroclysis. In addition, sonoenteroclysis showed thickened bowel wall with loss of stratification. Extraintestinal findings such as enlarged lymph nodes and ascites were also disclosed at the time of sonography. These were diagnosed subsequently as cases of tuberculosis (n = 23), celiac disease (n = 6), adenocarcinoma (n = 2), leiomyoma (n = 2), Immunoproliferative small intestinal disease (n = 1), and segmental enteritis (n = 1).
The diagnostic accuracy of sonoenteroclysis for detecting small bowel lesions is comparable to that of barium enteroclysis. This new, widely available, inexpensive, and undemanding technique can be used as an initial investigation in the evaluation of patients with small bowel disorders.
小肠的放射学评估通常通过钡剂检查进行，这会涉及大量辐射暴露。一种新的超声检查方法——超声小肠造影，是诊断小肠疾病的一种有前景的技术。在本研究中，评估了超声小肠造影的适用性、性能及诊断率，并将这种新方法的结果与钡剂小肠造影的结果进行了比较。
对连续45例疑似小肠疾病的患者进行研究。所有患者在经鼻空肠管（改良的比尔鲍·多特管）输注含聚乙二醇的等渗不可吸收电解质溶液前后均接受腹部超声检查，并获取不同层面的图像。记录小肠壁厚度、管腔狭窄、肠扩张、蠕动及肠外并发症情况。随后进行钡剂小肠造影并记录结果。将超声小肠造影的结果与钡剂小肠造影的结果进行比较。
在34.4±18.4分钟内可依次清晰显示空回肠袢，实现肠腔满意扩张。45例患者中，10例在超声小肠造影和钡剂小肠造影中显示小肠正常。这10例患者作为对照。超声小肠造影显示空肠和回肠正常直径分别小于3.0 cm和2.0 cm。肠壁厚度为1.7至3.0 mm，肠壁的五层结构均可清晰显示。黏膜皱襞清晰可见，皱襞厚度在1.4至2.0 mm之间。其余35例患者在超声小肠造影和钡剂小肠造影中均显示有狭窄、肠袢缠结、肠袢扩张、皱襞增厚、回盲部变形、肿块病变等异常。此外，超声小肠造影显示肠壁增厚且层次消失。超声检查时还发现了如肿大淋巴结和腹水等肠外表现。这些患者随后被诊断为结核病（n = 23）、乳糜泻（n = 6）、腺癌（n = 2）、平滑肌瘤（n = 2）、免疫增殖性小肠病（n = 1）和节段性肠炎（n = 1）。
超声小肠造影检测小肠病变的诊断准确性与钡剂小肠造影相当。这种新的、广泛可用、价格低廉且要求不高的技术可作为评估小肠疾病患者的初步检查方法。
